In this proposed competing renewal of a randomized trial of Programs of Assertive Community Treatment (PACT), for severely mentally ill adults, we are seeking two years of support to complete the follow-up assessments on clients enrolled in this study and to analyze the client family and cost data. Due to delays in recruiting the sample (largely a function of Hurricane Hugo), to underestimating the time arid effort necessary to obtain the cost data and allocating a very limited amount of time (3 months) for data analysis, additional time is required to complete the original study aims. In two and one-half years we have enrolled the patient cohort and completed the six month follow-ups. This continuation will achieve the following tasks: 1) complete 12 and 18 month interviews with clients, case managers and family members on 154 enrolled clients; 2) obtain cost data (health, mental health, jail/correctional/courts, family and maintenance (SSI, SSDI) for the 6-, 12- and 18-month follow-up periods; 3) analyze the effects of the experimental intervention on client symptoms, functioning and quality of life at 6, 12 and 18 month periods; 4) analyze the effects of the experimental intervention on service utilization for each follow up period; and 5) evaluate the overall cost and effectiveness of PACT relative to the comparison condition (a community mental health center with case management and a mobile crisis team). Specific hypotheses will be tested in the areas of mental health status, patient functioning, quality of life, health and mental health services use and costs. Increased interest in this important intervention is manifest in the initiation of a number of randomized trials of PACT since the start of this study. The current study is significant from a number of perspectives: 1) comparison with a state-of-the-art community approach; 2) a complete assessment of costs; 3) attention to special populations, particularly black clients (60 percent) and dually diagnosed persons (one-fourth have substance abuse secondary to a psychotic disorder); 4) a longer follow-up period than observed in most case management studies (18 months); and 5) evaluation of a mature program. This study is offered as a Public Academic Liaison (PAL) because of its integral and essential relationships with the State of South Carolina, the local community mental health program, the Medical University of South Carolina and two private academic institutions, Duke and Johns Hopkins Universities. It is also responsive to the Effectiveness and Outcomes of Mental Health Services RFA and to the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.